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Yang Y, Li S, Yang Y, Zeng T, Li J, Tang Y. Immunosuppressive Therapy Reversing Obstructive Hydrocephalus in CLIPPERS. Neurology 2024; 102:e209396. [PMID: 38593397 DOI: 10.1212/wnl.0000000000209396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Yi Yang
- From the Departments of Neurology (Yi Yang, T.Z., Y.T.) and Infectious Diseases (S.L.), Mianyang Central Hospital, University of Electronic Science and Technology of China; Department of Neurology (Yi Yang, J.L.), West China Hospital, Sichuan University; and Department of Neurology (Yang Yang), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Shuhua Li
- From the Departments of Neurology (Yi Yang, T.Z., Y.T.) and Infectious Diseases (S.L.), Mianyang Central Hospital, University of Electronic Science and Technology of China; Department of Neurology (Yi Yang, J.L.), West China Hospital, Sichuan University; and Department of Neurology (Yang Yang), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yang Yang
- From the Departments of Neurology (Yi Yang, T.Z., Y.T.) and Infectious Diseases (S.L.), Mianyang Central Hospital, University of Electronic Science and Technology of China; Department of Neurology (Yi Yang, J.L.), West China Hospital, Sichuan University; and Department of Neurology (Yang Yang), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ting Zeng
- From the Departments of Neurology (Yi Yang, T.Z., Y.T.) and Infectious Diseases (S.L.), Mianyang Central Hospital, University of Electronic Science and Technology of China; Department of Neurology (Yi Yang, J.L.), West China Hospital, Sichuan University; and Department of Neurology (Yang Yang), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jinmei Li
- From the Departments of Neurology (Yi Yang, T.Z., Y.T.) and Infectious Diseases (S.L.), Mianyang Central Hospital, University of Electronic Science and Technology of China; Department of Neurology (Yi Yang, J.L.), West China Hospital, Sichuan University; and Department of Neurology (Yang Yang), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yufeng Tang
- From the Departments of Neurology (Yi Yang, T.Z., Y.T.) and Infectious Diseases (S.L.), Mianyang Central Hospital, University of Electronic Science and Technology of China; Department of Neurology (Yi Yang, J.L.), West China Hospital, Sichuan University; and Department of Neurology (Yang Yang), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Li EC, Lai QL, Cai MT, Fang GL, Fang W, Zheng Y, Du Y, Du BQ, Shen CH, Qiao S, Ding MP, Zhang YX. Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS): contemporary advances and current controversies. J Neurol 2024; 271:1747-1766. [PMID: 38286842 DOI: 10.1007/s00415-024-12189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/31/2024]
Abstract
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory syndrome with characteristic clinical, radiological, and pathological features, and can be effectively treated with corticosteroid-based immunotherapies. The exact pathogenesis of CLIPPERS remains unclear, and specific diagnostic biomarkers are not available. According to the 2017 diagnostic criteria, probable CLIPPERS should be considered in middle-aged patients with subacute onset of pontocerebellar symptoms and typical punctuate and curvilinear gadolinium enhancement lesions ("salt-and-pepper" appearance) located in the hindbrain (especially pons) on magnetic resonance imaging. In addition, CLIPPERS-mimics, such as central nervous system (CNS) lymphoma, and several antibody-associated autoimmune CNS diseases (e.g., myelin oligodendrocyte glycoprotein antibody-associated disease, autoimmune glial fibrillary acidic protein astrocytopathy, and anti-N-methyl-D-aspartate receptor encephalitis), should be extensively excluded. The prerequisite for definite CLIPPERS is the perivascular T-cell-predominant inflammatory infiltration observed on pathological analysis. A biopsy is strongly suggested when clinical/radiological red flags are present. Most patients with CLIPPERS respond well to corticosteroids and have a good prognosis. Long-term low-dose corticosteroid maintenance therapy or corticosteroids coupled with immunosuppressants are recommended to prevent the recurrence of the syndrome. The potential progression of CLIPPERS to lymphoma has been suggested in some cases; therefore, at least 2-year clinical and radiological follow-up is essential. Here, we critically review the recent developments and provided an update on the clinical characteristics, diagnostic criteria, differential diagnoses, and therapeutic management of CLIPPERS. We also discuss the current controversies in this context that can be resolved in future research studies.
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Affiliation(s)
- Er-Chuang Li
- Department of Neurology, Taikang Ningbo Hospital, Ningbo, 315042, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, 310013, China
| | - Meng-Ting Cai
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, China
| | - Wei Fang
- Department of Neurology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310007, China
| | - Yang Zheng
- Department of Neurology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Ye Du
- Department of Neurology, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Bing-Qing Du
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Chun-Hong Shen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Song Qiao
- Department of Neurology, Zhejiang Hospital, Hangzhou, 310013, China
| | - Mei-Ping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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